FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-97764
1. WellPoint Health Networks WELLPAC
1 WellPoint Way T2-1A6Thousand Oaks, CA 91362
Fax: 0-
Email: Susan.Nagy@wellpoint.com
2. Date: 10/15/2003
3. FEC Committee ID #: C00197228 This committee is a Separate Segregated FundAffiliated Committees/Organizations
Blue Cross & Blue Shield United of Wisconsin Political Action Committee401 W. Michigan St.
Milwaukee, Wisconsin 53201
Relationship: affiliated
Custodian of Records:
Nancy Thompson1 WellPoint Way T2-1A6
Thousand Oaks, CA 91362
Title: Executive Assistant
Phone # (805) 557-6787
Treasurer:
Callen M. Lockett1 WellPoint Way T2-1A6
Thousand Oaks, California 91362
Title: VP Public Affairs
Phone # (805) 557-6888
Designated Agent(s):
Susan Nagy1 WellPoint Way T2-1A6
Thousand Oaks, California 91362
Title: Manager
Phone # (805) 557-6788
Banks or Depositories
Bank of AmericaP.O. Box 27128
Concord, California 94520
Signed: Callen M. Lockett
Date Signed: 11/20/2002
Official Committee FAX: 0-
FORM TEXT